Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Gastroenterology, Pediatrics, EndocrinologyMedium impact
Serologic Diagnosis of Celiac Disease
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
This policy was last reviewed 06/24/2024 with no changes. Serologic measurement of tissue transglutaminase or antiendomysial antibodies may be considered medically necessary in patients with signs or symptoms suggestive of celiac disease when more common pathogens have been previously ruled out, with testing limited to once per lifetime. Serological testing is considered medically necessary to screen persons with type 1 diabetes mellitus for celiac disease. Serologic measurement of deamidated gliadin peptide antibodies (CPT 86258) and screening of asymptomatic at-risk groups or the general population are investigational.
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01Billing team: Bill CPT 86231 (endomysial antibody, each immunoglobulin class) and CPT 86364 (tissue transglutaminase, each immunoglobulin class) for signs or symptoms suggestive of celiac disease only when more common pathogens have been previously ruled out, and limit testing to once per lifetime.
02Bill serologic screening for celiac disease in members with type 1 diabetes mellitus as medically necessary.
03Do not bill CPT 86258 as medically necessary for signs or symptoms of celiac disease, since it is investigational and BCBSMS makes no payment for services not documented to be Medically Necessary.
04HLA-DQ2 and HLA-DQ8 testing may be considered medically necessary to rule out celiac disease when serologic and histologic findings are discordant, or when persistent symptoms warrant testing despite negative serology and histology.
Codes mentioned
862318636486258K90.0
Original notice
Serologic Diagnosis of Celiac Disease
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